September is Alzheimer's and Dementia Awareness Month, a time to recognize the millions of families across the country who are quietly doing one of the hardest things a person can do: caring for someone they love through a disease that changes everything, including who that person is.
At BrightStar Care of Evanston and Northbrook, we spend a lot of time with those families. We hear about the challenges that do not always make it into the brochures. And one of the most exhausting, most disorienting, and most undertalked-about challenges is sundowning.
If you have ever watched a parent or spouse who seemed calm and manageable during the day become someone almost unrecognizable by late afternoon, agitated, confused, suspicious, inconsolable you already know what sundowning is. This post is for you. It will not make it easy. But it may help make it more understandable, and more manageable.
Call Us 847-510-5750 Our Website
Sundowning, sometimes called late-day confusion or sundown syndrome, refers to a pattern of increased agitation, confusion, anxiety, and behavioral disturbance that occurs in the late afternoon and evening hours in people with Alzheimer's disease and other forms of dementia.
The term is descriptive: symptoms tend to worsen as the sun goes down. For some people the pattern is fairly predictable, starting around 3 or 4 in the afternoon and peaking in the early evening. For others it is less consistent but still clearly tied to the later part of the day.
Sundowning is not a separate diagnosis. It is a symptom pattern one that occurs in a significant portion of people with dementia, with estimates ranging from 20 to 45 percent of those with Alzheimer's disease experiencing it at some point in their illness.
Families often describe sundowning as a switch being flipped. The person who was relatively calm and oriented during the morning becomes someone difficult to reach by mid-afternoon.
Common presentations include:
Increased restlessness and pacing an inability to settle, a need to move that the person cannot articulate or explain. Agitation and irritability that seems to come from nowhere, directed at caregivers, family members, or no one in particular. Confusion about time, place, and identity, not knowing where they are, believing they need to go somewhere, asking repeatedly for people who are no longer living. Suspicion and paranoia accusing caregivers or family members of stealing, lying, or keeping them somewhere against their will. Emotional distress crying, fearfulness, calling out. Resistance to care, refusing to eat dinner, refusing to take medications, refusing to prepare for bed.
For family caregivers and professional caregivers alike, the late afternoon and evening hours become the hardest part of the day. By the time sundowning peaks, everyone is tired and the person with dementia is at their most difficult to reach.
The honest answer is that researchers do not fully understand sundowning, and the causes are likely multiple and overlapping. Several factors appear to contribute.
Disruption of the internal clock. Alzheimer's disease and other dementias damage the parts of the brain involved in regulating circadian rhythms, the internal clock that governs sleep-wake cycles, hormone release, and alertness. When those regulatory systems are disrupted, the brain loses its ability to orient to time of day in a reliable way. The signals that tell a healthy brain it is evening and time to wind down may become mixed, absent, or distorted.
Fatigue accumulation. People with dementia expend significant cognitive energy throughout the day managing the confusion and disorientation their condition creates. By late afternoon, that reserve is depleted. The behavioral and emotional regulation that was possible earlier in the day becomes harder to maintain when the person is mentally and physically exhausted.
Light and sensory changes. Fading natural light in the late afternoon and evening removes environmental cues that help orient people to time and place. Shadows, reflections, and lower light levels can cause visual misperceptions seeing shapes in shadows, misidentifying familiar people or objects. For a brain that is already struggling to interpret sensory information accurately, the reduced-light environment of early evening creates additional confusion.
Disrupted sleep architecture. Dementia commonly disrupts normal sleep patterns, leading to fragmented nighttime sleep, daytime napping, and a blurring of the distinction between day and night. The resulting sleep deprivation compounds the cognitive and behavioral symptoms of the disease and makes sundowning worse.
Unmet physical needs. Pain, hunger, thirst, constipation, urinary tract infections, and other physical discomforts can drive or amplify behavioral symptoms in people with dementia who lack the ability to communicate those needs clearly. Sundowning that seems to worsen suddenly or significantly may have an underlying physical cause worth investigating with the physician.
Contact BrightStar Care of Evanston & Northbrook:
There is no medication or intervention that eliminates sundowning. But there is a meaningful evidence base for strategies that reduce its severity and frequency. Most of them center on the environment, the routine, and the quality of human presence during the difficult hours.
Light therapy and bright daytime exposure. One of the most consistently supported interventions for sundowning is maximizing bright light exposure during the day. Keeping the home well-lit, spending time near windows or outdoors during daylight hours, and using bright-light therapy lamps in the morning can help reinforce circadian rhythms and reduce late-day confusion. Correspondingly, reducing evening light gradually and avoiding harsh overhead lighting as dusk approaches can ease the transition into evening.
Consistent daily routine. Predictability is a form of safety for people with dementia. A consistent structure to the day meals at the same time, activity in the morning, rest in the early afternoon, a calming wind-down routine in the late afternoon gives the brain environmental cues it can rely on when internal cues are failing. Disruptions to that routine, including visitors, outings, or schedule changes, can trigger or worsen sundowning.
Activity calibration. Scheduling meaningful, engaging activities for the morning and early afternoon when the person is at their cognitive best and shifting to quieter, lower-demand activities in the late afternoon reduces the cognitive and physical fatigue that contributes to sundowning. A walk in the morning, music or a familiar television program in the afternoon, a simple familiar task in the early evening.
Managing the late-afternoon environment. In the hours when sundowning typically occurs, the environment matters enormously. Reducing noise and stimulation, softening lighting, turning off the television if it is creating confusion, playing calm familiar music, and ensuring the space feels safe and familiar can all reduce the intensity of symptoms. Some families find that certain familiar objects such as a worn sweater, a favorite blanket, family photographs provide grounding during agitated periods.
Calm, reassuring presence. The quality of human interaction during sundowning episodes matters as much as environmental management. Arguing with the person about what is real, correcting their confusion, or trying to reason them out of an agitated state typically escalates symptoms rather than resolving them. A calm, unhurried presence speaking quietly, using the person's name, validating their feelings without reinforcing the specific content of their confusion is more effective than logical correction. "I can see you're worried. I'm here and you're safe" is almost always more helpful than "No, that's not true, you're at home."
Addressing physical needs proactively. Ensuring the person is hydrated, comfortable, and not hungry in the late afternoon removes one common driver of agitation. A small snack and a warm decaffeinated drink in the late afternoon can be both a physical intervention and a routine anchor.
Reviewing medications. Some medications can worsen confusion and agitation, particularly in the evening. If sundowning is severe or has worsened significantly, a conversation with the prescribing physician about the medication regimen is worthwhile.
Call Us 847-510-5750 Our Website
Sundowning is one of the primary reasons families reach the limit of what a single caregiver — family or professional can sustain. The late-afternoon peak means that the hardest hours of the day consistently arrive at the end of the day, when everyone is most tired. Managing a person who is agitated, resistant, and disoriented for several hours every evening is physically and emotionally exhausting work, and it does not stop on weekends or holidays.
For families in Evanston, Northbrook, and surrounding North Shore communities who are managing a loved one with dementia at home, BrightStar Care provides non-medical caregiving support that can make an enormous difference during those difficult hours and through the night.
Evening and overnight caregiver support means that the peak hours of sundowning do not have to fall entirely on a family member who has already been caregiving all day. A consistent, trained caregiver who knows your loved one, understands their patterns, and can provide calm, skilled presence during the late afternoon and evening can change the experience for everyone in the household.
24-hour caregiving is the right fit for families whose loved one's sundowning has progressed to the point where nighttime safety is a concern wandering, falls, attempting to leave the home, or severe overnight agitation. BrightStar Care's 24-hour caregiving model uses rotating shift caregivers, ensuring your loved one always has an alert, rested caregiver present. This is different from live-in care, where a single caregiver is expected to be available around the clock. Our shift-based model means consistent coverage without the risks that come from a fatigued sole caregiver.
Our caregivers are trained in dementia care and in the specific communication and de-escalation approaches that work during sundowning episodes. They do not come in as strangers each evening they become familiar, consistent presences in your loved one's daily life, which itself reduces the anxiety and suspicion that drive sundowning symptoms.
Alzheimer's and Dementia Awareness Month is an opportunity to name what many families are living through privately and without enough support. Sundowning is one of the least-discussed and most disruptive features of life with dementia not because it is rare, but because it tends to happen behind closed doors, in the evening hours, when families are managing it alone.
If you are caring for someone in the Evanston or Northbrook area and the evenings have become the hardest part of your day, you do not have to keep managing them alone. BrightStar Care is here to help with trained caregivers, flexible scheduling, and 24-hour support for families who need it.
Call Us 847-510-5750 Our Website
BrightStar Care of Evanston & Northbrook provides professional non-medical caregiving services for seniors and adults throughout Evanston, Northbrook, and the surrounding North Shore communities of Illinois. Our caregivers are trained in dementia care and available for part-time, full-time, evening, overnight, and 24-hour shifts. To speak with a care coordinator about support for your loved one this September and beyond, contact our office today.
Call Us 847-510-5750 Our Website
At BrightStar Care of Evanston and Northbrook, we spend a lot of time with those families. We hear about the challenges that do not always make it into the brochures. And one of the most exhausting, most disorienting, and most undertalked-about challenges is sundowning.
If you have ever watched a parent or spouse who seemed calm and manageable during the day become someone almost unrecognizable by late afternoon, agitated, confused, suspicious, inconsolable you already know what sundowning is. This post is for you. It will not make it easy. But it may help make it more understandable, and more manageable.
Call Us 847-510-5750 Our Website
What Is Sundowning?
Sundowning, sometimes called late-day confusion or sundown syndrome, refers to a pattern of increased agitation, confusion, anxiety, and behavioral disturbance that occurs in the late afternoon and evening hours in people with Alzheimer's disease and other forms of dementia.The term is descriptive: symptoms tend to worsen as the sun goes down. For some people the pattern is fairly predictable, starting around 3 or 4 in the afternoon and peaking in the early evening. For others it is less consistent but still clearly tied to the later part of the day.
Sundowning is not a separate diagnosis. It is a symptom pattern one that occurs in a significant portion of people with dementia, with estimates ranging from 20 to 45 percent of those with Alzheimer's disease experiencing it at some point in their illness.
What It Actually Looks Like
Families often describe sundowning as a switch being flipped. The person who was relatively calm and oriented during the morning becomes someone difficult to reach by mid-afternoon.Common presentations include:
Increased restlessness and pacing an inability to settle, a need to move that the person cannot articulate or explain. Agitation and irritability that seems to come from nowhere, directed at caregivers, family members, or no one in particular. Confusion about time, place, and identity, not knowing where they are, believing they need to go somewhere, asking repeatedly for people who are no longer living. Suspicion and paranoia accusing caregivers or family members of stealing, lying, or keeping them somewhere against their will. Emotional distress crying, fearfulness, calling out. Resistance to care, refusing to eat dinner, refusing to take medications, refusing to prepare for bed.
For family caregivers and professional caregivers alike, the late afternoon and evening hours become the hardest part of the day. By the time sundowning peaks, everyone is tired and the person with dementia is at their most difficult to reach.
Why Does Sundowning Happen?
The honest answer is that researchers do not fully understand sundowning, and the causes are likely multiple and overlapping. Several factors appear to contribute.Disruption of the internal clock. Alzheimer's disease and other dementias damage the parts of the brain involved in regulating circadian rhythms, the internal clock that governs sleep-wake cycles, hormone release, and alertness. When those regulatory systems are disrupted, the brain loses its ability to orient to time of day in a reliable way. The signals that tell a healthy brain it is evening and time to wind down may become mixed, absent, or distorted.
Fatigue accumulation. People with dementia expend significant cognitive energy throughout the day managing the confusion and disorientation their condition creates. By late afternoon, that reserve is depleted. The behavioral and emotional regulation that was possible earlier in the day becomes harder to maintain when the person is mentally and physically exhausted.
Light and sensory changes. Fading natural light in the late afternoon and evening removes environmental cues that help orient people to time and place. Shadows, reflections, and lower light levels can cause visual misperceptions seeing shapes in shadows, misidentifying familiar people or objects. For a brain that is already struggling to interpret sensory information accurately, the reduced-light environment of early evening creates additional confusion.
Disrupted sleep architecture. Dementia commonly disrupts normal sleep patterns, leading to fragmented nighttime sleep, daytime napping, and a blurring of the distinction between day and night. The resulting sleep deprivation compounds the cognitive and behavioral symptoms of the disease and makes sundowning worse.
Unmet physical needs. Pain, hunger, thirst, constipation, urinary tract infections, and other physical discomforts can drive or amplify behavioral symptoms in people with dementia who lack the ability to communicate those needs clearly. Sundowning that seems to worsen suddenly or significantly may have an underlying physical cause worth investigating with the physician.
Contact BrightStar Care of Evanston & Northbrook:
- Phone: 847-510-5750
- Address: 950 Skokie Blvd, Ste 301, Northbrook, IL 60062
- Visit Us Online: BrightStar Care Northbrook/Evanston
What Helps: Evidence-Informed Strategies for Families
There is no medication or intervention that eliminates sundowning. But there is a meaningful evidence base for strategies that reduce its severity and frequency. Most of them center on the environment, the routine, and the quality of human presence during the difficult hours.Light therapy and bright daytime exposure. One of the most consistently supported interventions for sundowning is maximizing bright light exposure during the day. Keeping the home well-lit, spending time near windows or outdoors during daylight hours, and using bright-light therapy lamps in the morning can help reinforce circadian rhythms and reduce late-day confusion. Correspondingly, reducing evening light gradually and avoiding harsh overhead lighting as dusk approaches can ease the transition into evening.
Consistent daily routine. Predictability is a form of safety for people with dementia. A consistent structure to the day meals at the same time, activity in the morning, rest in the early afternoon, a calming wind-down routine in the late afternoon gives the brain environmental cues it can rely on when internal cues are failing. Disruptions to that routine, including visitors, outings, or schedule changes, can trigger or worsen sundowning.
Activity calibration. Scheduling meaningful, engaging activities for the morning and early afternoon when the person is at their cognitive best and shifting to quieter, lower-demand activities in the late afternoon reduces the cognitive and physical fatigue that contributes to sundowning. A walk in the morning, music or a familiar television program in the afternoon, a simple familiar task in the early evening.
Managing the late-afternoon environment. In the hours when sundowning typically occurs, the environment matters enormously. Reducing noise and stimulation, softening lighting, turning off the television if it is creating confusion, playing calm familiar music, and ensuring the space feels safe and familiar can all reduce the intensity of symptoms. Some families find that certain familiar objects such as a worn sweater, a favorite blanket, family photographs provide grounding during agitated periods.
Calm, reassuring presence. The quality of human interaction during sundowning episodes matters as much as environmental management. Arguing with the person about what is real, correcting their confusion, or trying to reason them out of an agitated state typically escalates symptoms rather than resolving them. A calm, unhurried presence speaking quietly, using the person's name, validating their feelings without reinforcing the specific content of their confusion is more effective than logical correction. "I can see you're worried. I'm here and you're safe" is almost always more helpful than "No, that's not true, you're at home."
Addressing physical needs proactively. Ensuring the person is hydrated, comfortable, and not hungry in the late afternoon removes one common driver of agitation. A small snack and a warm decaffeinated drink in the late afternoon can be both a physical intervention and a routine anchor.
Reviewing medications. Some medications can worsen confusion and agitation, particularly in the evening. If sundowning is severe or has worsened significantly, a conversation with the prescribing physician about the medication regimen is worthwhile.
Call Us 847-510-5750 Our Website
When One Caregiver Is Not Enough
Sundowning is one of the primary reasons families reach the limit of what a single caregiver — family or professional can sustain. The late-afternoon peak means that the hardest hours of the day consistently arrive at the end of the day, when everyone is most tired. Managing a person who is agitated, resistant, and disoriented for several hours every evening is physically and emotionally exhausting work, and it does not stop on weekends or holidays.For families in Evanston, Northbrook, and surrounding North Shore communities who are managing a loved one with dementia at home, BrightStar Care provides non-medical caregiving support that can make an enormous difference during those difficult hours and through the night.
Evening and overnight caregiver support means that the peak hours of sundowning do not have to fall entirely on a family member who has already been caregiving all day. A consistent, trained caregiver who knows your loved one, understands their patterns, and can provide calm, skilled presence during the late afternoon and evening can change the experience for everyone in the household.
24-hour caregiving is the right fit for families whose loved one's sundowning has progressed to the point where nighttime safety is a concern wandering, falls, attempting to leave the home, or severe overnight agitation. BrightStar Care's 24-hour caregiving model uses rotating shift caregivers, ensuring your loved one always has an alert, rested caregiver present. This is different from live-in care, where a single caregiver is expected to be available around the clock. Our shift-based model means consistent coverage without the risks that come from a fatigued sole caregiver.
Our caregivers are trained in dementia care and in the specific communication and de-escalation approaches that work during sundowning episodes. They do not come in as strangers each evening they become familiar, consistent presences in your loved one's daily life, which itself reduces the anxiety and suspicion that drive sundowning symptoms.
This September: Seeing Dementia Clearly
Alzheimer's and Dementia Awareness Month is an opportunity to name what many families are living through privately and without enough support. Sundowning is one of the least-discussed and most disruptive features of life with dementia not because it is rare, but because it tends to happen behind closed doors, in the evening hours, when families are managing it alone.If you are caring for someone in the Evanston or Northbrook area and the evenings have become the hardest part of your day, you do not have to keep managing them alone. BrightStar Care is here to help with trained caregivers, flexible scheduling, and 24-hour support for families who need it.
Call Us 847-510-5750 Our Website
Frequently Asked Questions
Q: Is sundowning the same in all types of dementia, or does it vary?
Sundowning occurs across different types of dementia but can vary in its presentation and timing. It is most commonly associated with Alzheimer's disease but also occurs in Lewy body dementia, vascular dementia, and frontotemporal dementia. In Lewy body dementia, the visual misperceptions and hallucinations that are characteristic of that condition can make sundowning particularly distressing. The underlying principles of management are similar across dementia types, though the specific triggers and effective responses may differ. A geriatric specialist or neurologist familiar with the specific dementia type can provide more tailored guidance.Q: Will sundowning get worse as dementia progresses?
In many people, sundowning does worsen as the disease advances, reflecting increasing disruption to the brain systems that regulate circadian rhythms and behavioral control. However, the pattern is not uniform some people experience significant sundowning in the middle stages of dementia that becomes less pronounced in the later stages, possibly because overall activity levels decline. The goal of management is to reduce the severity and duration of episodes at whatever stage the person is in, and to ensure that the caregiving support in place is matched to the current level of need.Q: When should I talk to the doctor about sundowning?
Always, if sundowning is causing significant distress or safety concerns. Your loved one's physician should know that sundowning is occurring and should have the opportunity to review the medication list for contributors, check for underlying physical causes like urinary tract infections or pain, and discuss whether any interventions are appropriate for your loved one's specific situation. If sundowning worsens suddenly or significantly, a medical evaluation is warranted to rule out an acute cause.BrightStar Care of Evanston & Northbrook provides professional non-medical caregiving services for seniors and adults throughout Evanston, Northbrook, and the surrounding North Shore communities of Illinois. Our caregivers are trained in dementia care and available for part-time, full-time, evening, overnight, and 24-hour shifts. To speak with a care coordinator about support for your loved one this September and beyond, contact our office today.
Call Us 847-510-5750 Our Website